A comparison of the modified essay question and multiple choice question formats: their relationship to clinical performance.

The Department of Family Medicine at Jefferson Medical College has used the modified essay question as the final examination format for its required third-year clerkship since 1976. To compare the family medicine modified essay question format with the multiple choice question format used in the other five required junior clerkships, examination scores from 2,174 Jefferson graduates (1976-1985) were correlated with scores on the examinations of the National Board of Medical Examiners (NBME), ratings of clinical performance in the required third-year clerkships, and ratings on four global areas of postgraduate competence. Grades on the multiple choice examination in internal medicine consistently yielded the highest correlations with NBME scores and with postgraduate ratings of medical knowledge. Performance on the modified essay examination in family medicine had the lowest correlations in these areas. The family medicine scores, however, consistently yielded the highest correlations with overall third-year clinical performance and with postgraduate performance in the areas of data-gathering skills, clinical judgment, and professional attitudes. These results indicate that the modified essay question format may provide a different and important parameter in the evaluation of medical trainees.